Myocardial salvage: angioplasty and coronary artery bypass.

Percutaneous transluminal coronary angioplasty has shown great promise in the treatment of acute myocardial infarction, both alone and in combination with thrombolysis. Because of time constraints, intravenous thrombolysis probably will emerge as the initial therapy of choice in most settings. Because thrombolysis often has a high incidence of reocclusion and recurrent ischemia, angioplasty will continue to play a role in relieving residual coronary artery stenosis. Coronary artery bypass surgery is not often used currently as sole therapy for acute myocardial infarction. Nonetheless, like angioplasty, bypass surgery plays a supporting role in relieving post-thrombolytic stenosis, as well as in treating complications of angioplasty.